Healthcare Provider Details

I. General information

NPI: 1447257456
Provider Name (Legal Business Name): SPRING MOUNTAIN REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W CHEYENNE AVE STE 105
LAS VEGAS NV
89129-8411
US

IV. Provider business mailing address

5155 S DURANGO DR STE 101
LAS VEGAS NV
89113-0174
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4401
  • Fax: 702-869-9904
Mailing address:
  • Phone: 702-869-4401
  • Fax: 702-869-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number294504
License Number StateNV

VIII. Authorized Official

Name: MS. ARLYNE SALONGA MICIANO
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 702-869-4401